应用二级脾蒂离断法行腹腔镜脾切除术的临床研究

Application of amputation of secondary spleen pedicle in laparoscopic splenectomy

目的：探讨应用二级脾蒂离断法行腹腔镜脾切除术的实用性、有效性与安全性。方法：回顾分析2012年9月至2014年9月为21例患者行腹腔镜二级脾蒂离断法脾切除术的临床资料。结果：21例患者均顺利完成手术。术中生命体征平稳,手术时间55-150 min,平均（78.4±27.3）min,术中出血量50-300 ml,平均（75.5±29.1）ml,术后胃肠功能恢复时间24-48 h,平均（31.0±15.1）h,术后48-72 h拔除腹腔引流管,术后切口感染1例,无出血、胃肠瘘、血栓、胰漏等严重并发症,术后住院6-10 d,平均（6.0±3.1）d。随访3个月至2年,患者均恢复良好,无严重并发症发生。结论：腹腔镜二级脾蒂离断法脾切除术是安全、有效的,具有减少术中出血、控制手术费用、减少胰尾损伤、降低胃肠瘘与术后脾热发生率等优点,值得临床推广应用。

Objective： To investigate the practicability,efficacy and safety of amputation of secondary spleen pedicle in laparoscopic splenectomy. Methods： Clinical data of 21 patients with application of amputation of secondary spleen pedicle in laparoscopic splenectomy from Sep. 2012 to Sep. 2014 were retrospectively analyzed. Results： Operations of all the 21 patients were successfully completed. Vital signs of those patients were smooth during operation. The operation time was 55-150 min with the mean of（ 78. 4 ±27. 3） min. Blood loss was 50-300 ml during operations,the mean was（ 75. 5 ± 29. 1） ml. The patients could normally take food after24-48 h with the average of（ 31. 0 ± 15. 1） h. The drainage tube was removed after 48 to 72 h. No severe complications such as bleeding,gastrointestinal fistula,thrombus,pancreatic leakage happened during hospitalization except of 1 postoperative incision infection. The postoperative hospital stay was（ 6. 0 ± 3. 1） d（ range,6-10 d）. No serious postoperative complication was found in 3-48 months following-up. Conclusions： The amputation of secondary spleen pedicle is relatively safe and effective for laparoscopic splenectomy,due to a reduced blood loss,controlled costs and reduced surgical trauma of pancreatic tail,gastrointestinal fistula,postoperative splenic fever,etc,is worthy of clinical application.